HIMSS VIRTUAL CONFERENCE

 HIMSS VIRTUAL SYMPOSIUM

 

Today I am attending the HIMSS Conference from my easy chair at home.  Otherwise the lack of travel challenges, expense and loss of time away from your primary office (which sometimes are enjoyable as a distraction from the hum-ho drone of daily practice life.

This "Second Life" approach to dissemination of knowledge gives the user a very real appearance of a "symposium" duplicated in a virtual world over the internet, one of the best applications of Web 2.0

Jonathan Bush, CEO  AthenaHealth, gave a very articulate and understandable view of the conundrum that doctors and healthcare face in adopting HIT.  Mr Bush correctly states it is like hitting a moving target that not only changes direction, and  speed, but enters new dimensions.  His  presentation reveals the confusion and stress the health information technology industry faces......he offers the reader the opinion that the government is asking for impossible things now and probably well into the future, the complexity of codes, numerators,denomitators. He points out the fact that the provider cannot even get reliable eligibility information or co-pay amounts at the point of service that are accurate.  There is paper everywhere and he does not feel there will be much less paper very soon. He bemoans the fact that EOBs still arrive in paper form. 

John Hamlaka, CIO,CareGroup, Harvard Medical School

Interoperability  Labs, CCHIT, Roadmap, SNOMED,

Historical development, privacy, HIPAA is not uniform, regional differences for privacy concerns from hospital to hospital.

Security standards must address these differences.

Guidelines 10 rules

AHIC USE CASES ROUNDS

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STREET DOC

Jay Parkinson MD practices family medicine and pediatrics in Williamsburg,Brookly, N.Y.  His approach to health information exchange has been to use it to revolutionize medical practice using commonly available software and special proprietary software to increase information to patients that most physicians leave to their staff, at considerable expense. Judging from the comments on his web site, this has produced commentary ranging from "ridiculous" to "way to go Jay"

Young physicians are not thoroughly indoctrinated in the "business of medicine"  They are idealistic and want to transform medical practice.  Some of us "older folks"  (myself excluded) have systems set up that we have become comfortable using, even if they don't work as well as we might think.  It's hard to invest a lifetime of education and practice and at the end realize it no longer works well.  The "younger generation" who I anoint with the term "generation T" (which stands for technology) should be encouraged to innovate. The system will pick and chose what thrives and what fails.  It will be along hard road to overcome entrenched systems.  Universal payor may simplify and further entrench outmoded system.

Dr Parkinson offers the following video excerpt. In the tradition of ER, Nip and Tuck, I like to call this "Street Doc"

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The Impact of HIT in 2018

Quote of the Day:
When you come to a fork in the road...take it.
--Yogi Berra

 

In my search across the galaxy for the future of health information technology, I came across my son's XBOX 360 and found some relevant video posted on "Placebo Journal", and thank you to blogger  kevin.md

Here it is

Part I, A Medical Odyssey

 

Part II....The Next Day

 

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Barriers to Health Information Exchange

Quote of the Day:
Everything that can be invented has been invented.
--Charles H. Duell

 

In this column I often write about promoting health information exchange.

In all cases, however, we must comply with HIPAA and place barriers for confidentiality and privacy to protect patients from unauthorized access to their health records without proper authorization.

Health Insurance Portability and Accountability Act of 1996 (HIPAA) is an expansive set of rules to privacy for patient information.  The lesser known aspects of it may be largely unknown by physicians.  I came across a survey of dentists which had some interesting information, although not all aspects apply to medical offices. It is available for a full read at:Dental Survey

Several lesser known requirements are:

Inventory and Control of all hardware and software

Security and disposal of all media

Log of maintenace of hardware/software

WRITTEN work station

Further details are in the article itself.

Such questions arise such as:

Should patients have the option to specify that their medical records not be shared on a common HIE?

Should there be an audit trail for 'shared information'?

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More on Health Information Exchanges

Although the advent of the RHIO as a business structure for the development of  Health Information Exchanges has largely failed to do what it was intended to do, the motivation for HIE will largely be driven by  CMS mandates and well as quality and safety concerns. 

(HealthDay News) -- "From 2004 through 2006, patient safety errors resulted in 238,337 potentially preventable deaths of U.S. Medicare patients and cost the Medicare program $8.8 billion, according to the fifth annual Patient Safety in American Hospitals Study

This analysis of 41 million Medicare patient records, released April 8 by HealthGrades, a health care ratings organization, found that patients treated at top-performing hospitals were, on average, 43 percent less likely to experience one or more medical errors than patients at the poorest-performing hospitals.

This analysis of 41 million Medicare patient records, released April 8 by HealthGrades, a health care ratings organization, found that patients treated at top-performing hospitals were, on average, 43 percent less likely to experience one or more medical errors than patients at the poorest-performing hospitals.

The overall medical error rate was about 3 percent for all Medicare patients, which works out to about 1.1 million patient safety incidents during the three years included in the analysis

"HealthGrades has documented in numerous studies the significant and largely unchanging gap between top-performing and poor-performing hospitals. It is imperative that hospitals recognize the benchmarks set by the Distinguished Hospitals for Patient Safety are achievable and associated with higher safety and markedly lower cost," Collier said. "

The entire article can be found at  Washington Post.

Of some interest to me is no mention whether their was a difference in the use of "health information technoloogy" between the "high achievers" and the underperforming" hospitals. Does anyone have statistics on this metric?

The Fifth Annual Health Grades Patient Safety in American Hospitals Study

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Consumer Health Information Exchange

We as health care providers, hospitals, laboratories, emergency departments and others view health information and data exchange through a narrow prism from our side of the health care system.

Patients (consumers) also have begun to form their own virtual world of support groups and education amongst themselves. For years there have been patient oriented support groups and organizations.

Web 2.0 now has some very innovative offerings for patients.

Healing in Community Online offers a "second life" aspect to these interchanges of support and education.  It's construct is much like the real world, with provider offices, laboratories, hospitals, and all the usual everyday accoutrements of healthcare.

Diabetes Mine offers a wealth of patient oriented commentary for diabetics.

Patients Like Me offers links to specific disease entities, which include these "communities:

Motor Neuron Disease

Anxiety

Bipolar

Depression

AIDS

Multiple Sclerosis

OCD (Obsessive-Compulsive Disorder)

Parkinson's Disease

PTSD (Post-Traumatic Stress Disorder)

Quote of the Day:
Light travels faster than sound so some people appear bright until you hear them speak.
--Joe Messmore

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Innovation

Quote of the Day:
If you really want to do something, you will find a way. If you don't, you will find an excuse.
--Anonymous

 

Clinicians each day face innovation, like it or not. It traverses our day from the hospital to our office and to our business engines.

Continuing medical education, and staff training are a key methodology of "technology transfer" from the boiler-rooms of academia and practice management gurus.

We are all involved in some aspect of the process, the rising impact of consumerism, monitoring of outcomes, performance measures, reimbursement based upon compliance with reporting these metrics, and the influx of information technology.

The past three years as a health informatics researcher, I have devoted much time by interviewing vendors and the different approaches they use for their own business models.  Understandably they are in it to make a profit.

Most observers realize that HIT has undergone a rapid evolution with many failures, and some successes.

In past years some vendors would offer "beta" systems to practices for a reduced amount to build their software. There were many problems with this approach. A clinical practice setting operates on a daily basis and does not have the IT resources to support the many software and/or hardware "bugs" that are part and parcel of poorly written or undeveloped software.

In the development of Health Information Exchanges I have seen many different approaches to this new challenge.

An early question from the vendors is "who are your stakeholders"

Sales people like to develop lists of hospitals and clinicians they can approach to display their wares. Some are ethical and truly are dedicated to improve health care by using HIT.  As a consultant and physician working with a company the company gains some credibilty by having a fellow physician "vette" their offering.  Unfortunately in this process I have investigated multiple companies and have disqualified most.  Many are smaller companies who do not have  adequate support. Many of their "demos" are fancy power point presentations which do not truly exhibit the flaws in the actual operation of their system.

Many of them are very "defocused" attempting to have a large marketing department and not focus on truly developing a pilot program to demonstrate their offering(s).  Some are not focused on health information exchanges and want to  use this as a marketing bridge for EMRs, transcription systems.  Many are the result of mergers, acquisitons, to expand the functionality of their offerings.  In some cases they market systems that are not truly connected.  In some cases they will offer a complete solution when they do not  have the pieces integrated, other than fancy tricolor glossy marketing pieces.  They often speak in terms that are unfamiliar to clinicians, such as "revenue cycle management".

They imply practices can "plug and play" as if it operates like a usb port on a personal computer.  This is inherent in their asp online solutions (also known as web 2.0). On the surface this has been offered as a "hosted application" residing elsewhere much like a "mainframe"  All the practice needs is a "thin client" (formerly known as a workstation. This is connected via the internet. We have al witnessed significant decline in internet performance which degrades swift data entry and/or retrieval.

Initially it is offered on a reasonable monthly subscription cost, much less than the investment of a inhouse client-server system

As the offer evolves you will find surcharges for training and maintenance charges.

If one truly wishes to research health IT, it is worthwhile to attend one of the annual HIMSS meetings.  www.himss.org

The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry's membership organization exclusively focused on providing leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. more >

Attend in the role of an interested observer, not as a place where  you select a vendor.

In my next blog we'll discuss weblog's that are resources for innovative ideas, and most important written by knowledgable experienced thought leaders.

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